For HIV-positive patients, cost considerations take on added importance because of the expensive antiretroviral prescription medications. As such, assessing premiums alone may not provide an accurate measure of plan affordability for HIV-positive patients.
The Affordable Care Act (ACA) expanded access to health coverage for millions of people, including those with HIV. For HIV-positive patients, cost considerations take on added importance because of the expensive antiretroviral prescription medications that these patients rely on and the importance of comprehensive health coverage to these chronically ill patients.
A new report by the Kaiser Family Foundation, “Marketplace Health Plan Options for People with HIV Under the ACA: An approach to more comprehensive cost assessment,” concluded that assessing premiums alone may not provide an accurate measure of plan affordability for HIV-positive patients because enrollees may find that they face unexpected or higher costs if premiums alone are used to guide plan selection in isolation.
“A more comprehensive assessment of the cost of coverage includes factors beyond just premiums, such as deductibles, drug costs, and out-of-pocket [OOP] maximums,” the report authors Lindsey Dawson and Jennifer Kates stated.
The analysis provides estimates of the costs HIV-positive individuals might expect to face when enrolled in marketplace health plans and describes the characteristics of plans that might offer the greatest value. Costs in 300 different enrollment scenarios are examined, looking at 5 plans in each of 5 sites for 2 enrollee types (one HIV-positive individual with well-managed HIV disease and no other chronic health needs, and one HIV-positive individual with significant HIV care needs) across various incomes. The analysis used 2 measures: expected health costs and total OOP liability.
Key findings include the following:
The plan enrollees select has significant consequences for their expected health costs. On average there was a $4054 difference between what they could expect to pay annually if enrolled in the plan with the lowest expected health costs compare with the plan with the highest. There was a $3914 difference in liability between what an enrollee could expect to face annually if enrolled in the plan with the lowest liability compared with the plan with the highest.